Specific dietary fibers prevent heavy metal disruption of the human gut microbiota in vitro.

Heavy metal exposure is a growing concern due to its adverse effects on human health, including the disruption of gut microbiota composition and function. Dietary fibers have been shown to positively impact the gut microbiota and could mitigate some of the heavy metal negative effects. This study aimed to investigate the effects of different heavy metals (As, Cd and Hg in different concentrations) on gut microbiota in the presence and absence of different dietary fibers that included fructooligosaccharides, pectin, resistant starch, and wheat bran. We observed that whereas heavy metals impaired fiber fermentation outcomes for some fiber types, the presence of fibers generally protected gut microbial communities from heavy metal-induced changes, especially for As and Cd. Notably, the protective effects varied depending on fiber types, and heavy metal type and concentration and were overall stronger for wheat bran and pectin than other fiber types. Our findings suggest that dietary fibers play a role in mitigating the adverse effects of heavy metal exposure on gut microbiota health and may have implications for the development of dietary interventions to reduce dysbiosis associated with heavy metal exposure. Moreover, fiber-type specific outcomes highlight the importance of evidence-based selection of prebiotic dietary fibers to mitigate heavy metal toxicity to the gut microbiota.

Macrolide and fluoroquinolone resistance of Mycoplasma genitalium in southern Spain, 2018-2019.

OBJECTIVES: In recent years, resistance in Mycoplasma genitalium (MG) to first-line (azithromycin) and second-line (moxifloxacin) treatment has been increasingly reported worldwide, however, no data regarding the south of Spain are available. METHODS: To determine resistance rates, MG-positive samples collected from June 2018 to June 2019 were analysed by sequencing the 23S rRNA and parC genes. RESULTS: A total of 77 patients (24 men having sex with men (MSM), 30 heterosexual men and 23 women) were included. Resistance-associated mutations against macrolide and fluoroquinolones were found in 36.4% (95% CI 25.7% to 48.1%) and 9.1% (95% CI 3.7% to 17.8%) of the patients, respectively. Being MSM and having had another STI in the last year were significantly associated with macrolide-resistant MG infection, while no associations were found with resistance to fluoroquinolones. CONCLUSIONS: Testing for resistance to first-line and second-line drugs against MG should be recommended for the general population and mandatory for the MSM population. We suggest that empiric azithromycin use for STI management should be avoided.

[Current status of alternative therapies renal function at the Instituto Mexicano del Seguro Social]. / Estado actual de las terapias sustitutivas de la función renal en el Instituto Mexicano del Seguro Social.

BACKGROUND: The IMSS performs systematically the data updating of patients with renal replacement therapy (RRT) by an electronic record management referred as: Census patients with Chronical Renal Failure (CIRC) which aims to meet the prevalence of patients with chronic renal failure and the behavior of RRTat the IMSS. METHODS: A retrospective study includes 212 secondary hospitals with dialysis programs, with both pediatric and adult patients. CIRC data obtained from January to December 2014, number and nominal bonds of peritoneal dialysis (PD) and hemodialysis (HD). Prevalence of patients and therapies by delegation, distribution by gender and age, cause of kidney disease, morbidity and mortality were identified. RESULTS: 55,101 patients, of whom 29,924 were male (54 %) and 25,177 women (46 %), mean age was 62.1 years (rng: 4-90); 20,387 were pensioners (36.9 %). The causes of renal failure were: diabetes 29,054 (52.7 %), hypertension 18,975 (34.4 %), chronic glomerulopathies 3,951 (7.2 %), polycystic kidneys 1,142 (2.1 %), congenital 875 (1.6 %) and other 1,104 (2 %). HD was given in 41 % of patients, and the remaining 59 % DP; the annual cost was 5,608,290,622 pesos. CONCLUSIONS: The increased prevalence of diabetes mellitus and hypertension affect the onset of RRT, which show a catastrophic financial outlook for the Institute.

Introducción: el IMSS realiza de manera sistemática la actualización de datos de los pacientes en terapias sustitutivas de la función renal (TSFR) mediante un registro electrónico denominado: Censo de administración de pacientes con Insuficiencia Renal Crónica (CIRC), cuyo objetivo es conocer la prevalencia de pacientes con insuficiencia renal crónica y el comportamiento de las TSFR en el IMSS. Métodos: estudio retrospectivo, incluye 212 hospitales de segundo nivel con programas de diálisis, pacientes pediátricos y adultos. Datos obtenidos del CIRC de enero a diciembre de 2014, cédulas numeral y nominal de diálisis peritoneal (DP) y hemodiálisis (HD). Se identifica prevalencia de pacientes y terapias por delegación, distribución por género y edad, causa de la enfermedad renal, la morbilidad y mortalidad. Resultados: 55 101 pacientes, de los cuales fueron 29 924 masculinos (54 %) y 25 177 femeninos (46 %); edad promedio 62.1 años (rng: 4 a 90); pensionados 20 387 (36.9 %). Las causas de la insuficiencia renal fueron: diabetes 29 054 (52.7 %), hipertensión arterial 18 975 (34.4%), glomerulopatías crónicas 3951 (7.2 %), riñones poliquísticos 1142 (2.1 %), congénitos 875 (1.6 %), y otras 1104 (2 %). La HD se otorgó en 41 % de los pacientes y la DP al 59 % restante; el costo anual fue de 5 608 290 622 pesos. Conclusiones: la prevalencia incrementada de diabetes mellitus e hipertensión arterial repercuten en el inicio de una TSFR, las cuales muestran un panorama financiero catastrófico para el Instituto.

Reaching targets for mineral metabolism clinical practice guidelines and its impact on outcomes among Mexican chronic dialysis patients.

BACKGROUND AND AIMS: An increasing number of studies have been published concerning meeting targets of clinical guidelines for different aspects of the diagnosis and treatment of patients with end-stage renal disease. Most of these studies have shown that guideline recommendations are not always satisfied, and results outside target limits have been associated with high rates of mortality and morbidity. The objective of this study was to analyze the frequency of reaching mineral and bone metabolism-related guideline targets and its impact on clinical outcomes in Mexican chronic dialysis patients. METHODS: A cohort of prevalent peritoneal dialysis (PD) and hemodialysis (HD) patients were analyzed at baseline and followed for at least 16 months. Patients were on continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD), and HD and contracted HD modalities where patients received HD sessions outside institution facilities. RESULTS: We studied 753 patients. The percentage of patients within target limits for phosphorus was 35%, for calcium 32%, and for PTH 12%. The most frequent pattern was hyperphosphatamia, hypercalcemia, and low PTH. This was even more frequent in CAPD patients, probably due to the high percentage of diabetic patients. Hypercalcemia was found as an independent risk factor for mortality. CONCLUSIONS: The most important results suggest that guideline recommendations are not usually satisfied and that hypercalcemia, in addition to other traditional risk factors, is associated with high mortality rates. The study also detected some opportunities to improve the quality of treatment by reducing the calcium content of dialysis solutions and reducing the use of calcium carbonate as a phosphate binder.

La consulta de enfermería, propuesta de mejora en los programas de diálisis peritoneal / The nursing interview, apropossal for improving the peritoneal dialisis program

Resumen

La consultoría de enfermería (CE) en los programas de diálisis peritoneal (DP) es una herramienta indispensable en la práctica diaria, el papel de la enfermera en diálisis juega un papel determinante en el éxito de los programas y en la permanencia de los pacientes que requieren de estas terapias. La actuación del profesional de enfermería con un enfoque holístico es fundamental en coordinación y coparticipación con el equipo multidisciplinario. La CE basa sus acciones en procesos sistematizados y planificados, sustentados en el conocimiento científico y legal en donde el objetivo principal es promover la cultura del autocuidado con la participación del paciente de manera efectiva, segura y eficaz. Los procedimientos específicos se auxilian de estrategias de docencia, educación en salud, investigación comunitaria y pública, servicio asistencial y administrativo, simultáneamente establece vínculos de apoyo y confianza del binomio enfermera-paciente; todas ellas reflejan su eficacia en la mejora de los indicadores de satisfacción del usuario, en la disminución de frecuencia de infecciones, mejora de la calidad de vida de los pacientes y probablemente repercutan en una mejora de la supervivencia. La propuesta de la implementación de la CE eficienta el proceso enfermero dirigido al paciente en terapia sustitutiva, fortaleciendo objetivos y metas de los programas.

Summary

The participation of nursing in the programs of peritoneal dialysis is actually daily an indispensable tool, the paper of the nurse in dialysis plays a determining role in the success of the programs and the permanence of the patients who require of these therapies. The action of the professional on nursing with a holistic approach is fundamental in coordination and co-participation with the multidisciplinary equipment. The participation nursing bases its actions on systematized and planned processes, sustained in the scientific and legal knowledge where the primary target is to the culture of the self care with the participation of the patient of effective, safe and effective way. The specific procedures are helped strategies for health, education, communitarian investigation and public, welfare and administrative service, simultaneously establishes bonds of support and confidence of the binomial nursepatient; all of them reflect their effectiveness in the improvement of the indicators of satisfaction of the patient, in the diminution of frequency of infections, improve of the quality of life and probably in an improvement of the survival. The propose of the implementation of the consulting nursing unit improves the nurse process directed to the patient in substitute therapy, fortifying objectives and goals of the programs.

When do vertical (stand-alone) programmes have a place in health systems?

Few issues related to the organization of health systems and service delivery have attracted as much attention as the debate on vertical versus integrated health programmes. The literature has focused on the comparative effectiveness of vertical (disease- or service-specific) versus more systemic approaches since the 1960s, and both approaches have been widely implemented in low- and middle-income countries and in high-income countries. In vertical approaches (also referred to as stand-alone, categorical, disease management or disease control programmes), interventions are provided through delivery systems that typically have separate administration and budgets, with varied structural, funding and operational integration with the wider health system. In the integrated model (also known as horizontal approaches or programmes), services do not have separate administration orbudgets and are typically delivered through health facilities that provide routine or general health services. This policy brief has three objectives and is structured accordingly: to unpack what is meant by a vertical programme versus an integrated one; to assess the available evidence and lessons on when vertical programmes have a role to play in health systems; and to indicate under what circumstances vertical programmes have a role to play in health systems and to note the factors policy-makers need to take into account when considering implementing vertical programmes.

Zoapatle XIII: isolation of water soluble fractions from montanoa frutescens and some biological activities

Se purificó el extracto crudo acuoso de zoapatle preparado con Montanoa frutescens utilizando filtrado con Sefadex G-50 y liofilización. Se obtuvo un material ambar, sólido, hidrosolubre que dio una respuesta positiva al reactivo de Lowry. Se estimó un peso molecular en el rango de 30,000, utilizando parámetros de elución. La fracción era varias veces más potente que el estracto crudo acuoso de zoapatle y mostró las mismas respuestas biológicas descritas previamente para el té